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This is the first of 2 tweets! #GalactoMagic
37M w/ cirrhosis on the liver transplant list has been in the ICU for 1 week for management of hepatorenal syndrome. His initial presentation was notable for fevers & dyspnea, but he was otherwise hemodynamically stable w/o hypoxia
This is the first of 2 tweets! #GalactoMagic
37M w/ cirrhosis on the liver transplant list has been in the ICU for 1 week for management of hepatorenal syndrome. His initial presentation was notable for fevers & dyspnea, but he was otherwise hemodynamically stable w/o hypoxia
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His fevers continued & then developed worsening hypoxemia requiring 2L O2. CT chest showed bilateral sub-centimeter lung nodules. Labs are sent and a diagnosis of Crypto is made. Serum beta-d-glucan later results; what would you expect its value to be? (ref range <31 pg/mL)?
His fevers continued & then developed worsening hypoxemia requiring 2L O2. CT chest showed bilateral sub-centimeter lung nodules. Labs are sent and a diagnosis of Crypto is made. Serum beta-d-glucan later results; what would you expect its value to be? (ref range <31 pg/mL)?
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Answer: <31. We've learned that there are 3 fungi that don't cause a + serum BDG: Blasto, Mucorales, Crypto. Looking at the Venn diagram, crypto is on the perimeter of the BDG circle. Crypto rarely causes a +BDG, and when it does, it's low level +
pubmed.ncbi.nlm.nih.gov/29125373/
Answer: <31. We've learned that there are 3 fungi that don't cause a + serum BDG: Blasto, Mucorales, Crypto. Looking at the Venn diagram, crypto is on the perimeter of the BDG circle. Crypto rarely causes a +BDG, and when it does, it's low level +
pubmed.ncbi.nlm.nih.gov/29125373/
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This multicenter study looked at test characteristics of BDG across multiple invasive fungal infections. Of the 12 pts with crypto, 2 had a positive BDG >80
pubmed.ncbi.nlm.nih.gov/16080087
This multicenter study looked at test characteristics of BDG across multiple invasive fungal infections. Of the 12 pts with crypto, 2 had a positive BDG >80
pubmed.ncbi.nlm.nih.gov/16080087
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However, there are studies showing +CSF BDG w/ crypto meningitis. One included 78 pts w/ HIV & crypto meningitis vs 39 controls. Median CSF BDG lvls were 343 among crypto cases & 37 in controls, ➡️ sens/spec of 89%/85% using cut-off of 80
jcm.asm.org/content/58/4/e…
However, there are studies showing +CSF BDG w/ crypto meningitis. One included 78 pts w/ HIV & crypto meningitis vs 39 controls. Median CSF BDG lvls were 343 among crypto cases & 37 in controls, ➡️ sens/spec of 89%/85% using cut-off of 80
jcm.asm.org/content/58/4/e…
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Cryptococcus is a yeast that can cause isolated pulmonary disease (as in our case), fungemia, and CNS disease.
The way in which it travels from the environment and through the human body is truly fascinating
As Isaac Asimov would say, a Fantastic Voyage!
Cryptococcus is a yeast that can cause isolated pulmonary disease (as in our case), fungemia, and CNS disease.
The way in which it travels from the environment and through the human body is truly fascinating
As Isaac Asimov would say, a Fantastic Voyage!
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We inhale spores that lay dormant (w/in macrophages) until there's a disruption in Th1 immunity ➡️ reactivation & dissemination
Crypto can employ a “Trojan horse” mechanism by moving intracellularly inside macrophages & being expelled in blood or CNS
onlinelibrary.wiley.com/doi/abs/10.111…
We inhale spores that lay dormant (w/in macrophages) until there's a disruption in Th1 immunity ➡️ reactivation & dissemination
Crypto can employ a “Trojan horse” mechanism by moving intracellularly inside macrophages & being expelled in blood or CNS
onlinelibrary.wiley.com/doi/abs/10.111…
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We’ve learned from a previous Tweetorial that cirrhosis is a RF for crypto, possibly due to impaired Kupffer cell activity in the liver. To help round out the other RF for crypto, here they are below!
onlinelibrary.wiley.com/doi/abs/10.111…
We’ve learned from a previous Tweetorial that cirrhosis is a RF for crypto, possibly due to impaired Kupffer cell activity in the liver. To help round out the other RF for crypto, here they are below!
onlinelibrary.wiley.com/doi/abs/10.111…
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Thank you for joining, stay tuned for another question tomorrow!
Thank you for joining, stay tuned for another question tomorrow!
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